Lack of Monitoring While on Coumadin Results in Patient’s Death

Joseph O'Neill

Written by
— Updated on May 12, 2016

Cardiology Expert WitnessThis case takes place in Arkansas and involves a patient who suffered injuries from taking Coumadin. The patient had experienced several minor heart episodes in the past, and as a result the defendant physician ordered that the patient begin a daily dose of Coumadin. Allegedly, the defendant physician did not advise the patient of the risks associated with Coumadin, or communicate the need for regular and periodic monitoring to ensure her safety. The defendant ordered no further monitoring of the patient’s status after writing the prescription for Coumadin. Eventually, the patient was rushed to the emergency room after being found unresponsive at her home, where a CT scan revealed she was suffering from a large internal hemorrhage. The physicians were able to stabilize the patient, however her condition never improved, and she later died. It is alleged that the defendants failed to inform the patient of the risks associated with taking Coumadin.

Question(s) For Expert Witness

  • 1. Do you have extensive experience treating patients with atrial fibrillation?
  • 2. What effects can Coumadin have on a patient if not strictly monitored?
  • 3. How often and precisely does a patient on Coumadin need to be monitored?

Expert Witness Response E-007567

I have extensive experience treating patients with atrial fibrillation. Coumadin has a widely proven benefit in preventing stroke in patients with atrial fibrillation. However this benefit must be weighed against the risk of bleeding. Even in a patient that is closely monitored, Coumadin has significant bleeding risks. Each patient has a variable response to the drug and it needs to be monitored closely until a safe and therapeutic range is achieved. Levels below this is are not effective at stroke prevention and levels above it increase the patient’s bleeding risk.  The patient should be monitored at least several times a week until the drug reaches therapeutic range.

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